Community health project is paying off
SOUTH Africa introduced a community-based primary health care programme in 2012. The aim of the programme, which includes a large HIV component, is to improve access to health care.
Under the programme, community health workers provide a wide range of services, such as health education and referrals to clinics for HIV testing and treatment. Community health workers also support people on antiretroviral therapy, and trace those who default on treatment.
By early 2017 there were about 3 276 teams of community health workers in 2590 of the 4392 wards in South Africa, with at least six community health workers in a team.
This country has the highest number of people – 7.1 million – living with HIV in the world. But new infections have decreased substantially, from 390000 in 2010 to 270000 in 2017.
This has been due to a number of successful interventions, including home-based care provided by community health workers.
Introduced at the height of the epidemic in 2003, home-based and community-based care sought to relieve the burden on clinics and hospitals, and to improve access to health care in under-served communities.
We did a study that examined the factors impacting on the success of the community-based HIV programme in a district in Limpopo, one of the more rural provinces.
Our findings showed that the community-based HIV programme has great potential to improve access to health care. But there are challenges.
Some suggestions we propose to scale up the work of community health workers include exploring approaches such as increasing staff numbers and getting community health workers to work during weekends to increase the number of households they service.
Providing HIV self-testing kits to communities can be used to increase HIV testing and mobile technology can help improve monitoring of community health worker activities by keeping accurate records of the number of households visited and services provided. Other possible solutions include having community health workers host awareness campaigns or “imbizos” for the community, leaders and traditional healers.
Finally, integrating HIV services with other chronic illness services so that people don’t have to wait in separate queues for different illnesses, may address stigma-related reasons for avoiding HIV care.
But financial investment to improve training, infrastructure and resources is urgently needed. And grassroots community involvement is vital to improve support and awareness of community health workers and to get buy-in for these health services.
Naidoo is an epidemiologist at the University of the Witwatersrand; Rees is an honorary research associate in Public Health Medicine at the University of Cape Town; and Peters is extraordinary professor in the Department of Medical Microbiology at the University of Pretoria. This article first appeared in The Conversation